Microsuction verses Irrigation to remove ear wax
The National Institute Of Clinical Excellence (NICE March 2024) Management of Ear Wax discusses and gives guidance for Health Care professionals. In this document it advises on ear wax removal by irrigation.
Rebecca and Joanna were trained at the National Ear Care Centre, Rotherham Foundation Trust, In both Microsuction and Irrigation acquiring a Diploma in Ear Care. These procedures are regulated by the CQC, and we are required to attend regular updates.
Our preference is to carry out Microsuction to clear wax from the ear canals, as there is a lower risk of infection and trauma to the ear. However, we were trained in Irrigation. If carried out safely within the guidelines, it can be very effective in removing difficult, problematic wax. However not all patients can have it, due to contraindications.
Microsuction
Microsuction involves inserting a suction tube into the ear canal. The suction tip is attached to a long plastic tube, which is then attached to a suction unit or machine. This sucks the wax from the ear down through the tube and into a disposable canister. A plastic speculum will hold the ear open and straighten the canal.
Magnifying the ear canal is important so the clinician can perform the procedure safely. The device used to magnify the ear can be a large wall mounted device (Microscope) or head worn (Loupes), or a video Otoscope.
You will need to keep the ears dry for 24 hours post procedure to prevent infection.
Pros
Quick
Effective
Gentle
Safe
The practitioner can see inside the ear canal (different equipment allows for varying levels of visibility)
It is not always necessary to use ear drops beforehand
Safe if you have perforated ears or have had surgery to your ears
No water, so less messy
Safe for those with mastoid cavities
Contraindications
Can be noisy
Not ideal if you are a nervous, anxious or jumpy person
Not the safest if someone is fidgety, has a cough or a medical condition that causes sudden jolts or movements
It may not always be possible to remove very deep wax with microsuction depending on the practitioners visual equipment
Very soft slushy wax can be harder and in some cases more dangerous to remove with microsuction
There is risk of human error and ear trauma if not used properly, or the patient moves suddenly
Can cause a temporary shift in hearing
Can cause tinnitus symptoms to get worse, or rarely start tinnitus symptoms
May trigger a cough reflex
Irrigation
Irrigation uses a gentle, regulated stream of water to dislodge wax blockages. A basin is held under the ear to catch the expelled wax and water. We still use magnification to look into the ear canal and check the health of the canal. You will need to keep the ear dry afterwards for 3-5 days to prevent infection
Pros
Quick
Effective
Gentle
The training and procedure is regulated
Easier and often safer when removing very deep wet wax
Better for softer wax, particularly when drops have been overused
Contraindications
Cannot be used if you have a history of a perforated ear drum
Should not be used if you have an active infection, or infection in the last 6 weeks
Cannot be used if you have a mastoid cavity
Caution advised if you have troublesome vertigo
Caution advised if you have had previous surgery
Should not be used if there are any open abrasions to the ear canal
There is risk of human error and ear trauma if not used properly
Cannot be used if you have hearing in only one ear
Cannot be used with grommets or grommets that have fallen out within 12 months
Cannot be used if you have a cleft palate, repaired or not
A previous bad experience with irrigation
Caution advised if you have a history of tinnitus
May cause vertigo whilst the procedure is carried out.
In conclusion. At Ear Matters Exeter, our preference is to carry out microsuction to clear wax from the ear canal. However we are fully trained and have the equipment to carry out irrigation, after a full assessment and discussion with our client.